| NPI | 1093133514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207T00000X Neurological Surgery (Licence: NM MD2022-1318) |
| Additional Taxonomies | 207T00000X Neurological Surgery (Licence: TX R7584) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2024-10-14 |